Assessing Risks of Glucose Lowering Therapy in Heart Failure: Should We Rely on Post-hoc Analyses?

摘要

Diabetes mellitus (DM) is common among patients with heart failure (HF), and each disease process likely potentiates the progression of the other. A number of recent clinical trials have brought significant attention to a possible association between glucose lowering therapy, particularly thiazolidinediones (TZDs) and dipeptidyl peptidase-4 (DPP4) inhibitors, and increased HF hospitalizations. While several of these studies have been well powered for major adverse cardiovascular events, none of them have included HF outcomes as part of their primary endpoints. Numerous post hoc analyses of these studies have shown inconclusive evidence as to whether or not there exists an association between these newer glucose lowering agents and HF. The aim of this review is to summarize the most current understanding of the effects of glucose lowering therapies in the development and progression of HF. Moreover, we review the existing evidence for glucose lowering therapies in diabetic patients with preexisting HF. Given the current ambiguity regarding whether these therapies contribute to or worsen HF, and given the poor prognosis associated with hospitalization for HF, prospective studies that specifically assess HF outcomes are needed to help guide therapy in this growing population of patients with comorbid DM and HF.